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Still Too Fat to Fight

We cannot succeed in teaching our children to eat


healthier foods while selling them 400 billion junk food
calories in our schools every year.
A Follow-up Report to Too Fat to Fight
Stlll 1oo lat to llght
Who We Are
MISSION: READINESS s the nonprot, nonpurtsun nutonu securty orgunzuton o senor retred mtury
euders cung or smurt nvestments n Amercu's chdren. lt operutes under the umbreu nonprot
Council for a Strong America.
lor u u stng o our membershp, peuse see our vebste ut vvv.mssonreudness.org.
Acknowledgments
MISSION: READINESS s supported by tux-deductbe contrbutons rom oundutons, ndvduus und
corporations. MISSION: READINESS uccepts no unds rom ederu, stute or ocu governments.
Muor undng or Msson: Reudness s provded by: rth to lve locy Aunce - 1he oeng
Compuny - 1he Cuornu Lducuton locy lund - 1he Cuornu Lndovment - 1he Anne L. Cusey
lounduton - Lury Cure und Lducuton lunders Couborutve o 1he \ushngton Areu \omen's
lounduton - 1he Crube lounduton - 1he Henz Lndovments - Robert \ood }ohnson lounduton -
\.l. leogg lounduton - 1he Duvd & Luce luckurd lounduton - \um lenn lounduton - 1he
lev Churtube 1rusts - 1he }.. & M.l. lrtzker lumy lounduton. 1he opnons expressed ure those o
the uuthor(s) und do not necessury reect the vevs o 1he lev Churtube 1rusts or other unders.
1hs report vus vrtten by \um Chrsteson, Amy Duvson 1uggurt, Soren Messner-Zde, Mke
lernun, }udy Cusck und Ryun Duy.
Duvd Currer, Lndsuy \urner, Nck Aexunder und Duvd luss uso contrbuted to ths report.
lhotos courtesy o the LS Depurtment o Deense.
2012 !"##"$%& ()*+"%)##
Stlll 1oo lat to llght
Summary
1he probem o unk ood sod n schoos s not ust u
national health issue. It is a national security issue.
Cver the pust 40 yeurs, obesty rutes huve more thun trped
for children and teens. About 1 in 4 young American adults
is now too overweight to join the military. Being overweight
or obese is the number one
medical reason why young
adults cannot enlist. When
weight problems are combined
vth poor educuton, crmnu
backgrounds and other
dsquuers, un estmuted 75
percent of young Americans
could not serve in the military if
they wanted to.
Meunvhe, too muny schoos
across America still have
vending machines and other
venues where children can
routney buy cundy, potuto
chps, cukes, cookes und sugur-
sweetened fruit juices or sports
drnks. 1he cuores udd up.
Accordng to u L.S. Depurtment
o Agrcuture survey, the totu
calories consumed in a year
from junk food sold at schools
is almost 400 billion calories. If
converted solely to the calories
n cundy burs, ths voud equu
neury 2 bon cundy burs,
which would weigh almost 90
thousand tons more than the weight of the aircraft carrier
Midway. lor more detus see puge 2, und Appendx l.
While limiting the sale of junk food is not a solution by itself
or the chdhood obesty epdemc, t s purt o the souton.
When schools sell candy and sugary drinks in cafeterias
und vendng muchnes, t vorks ugunst nutonu eorts to
serve healthier school meals and parents efforts to help their
children develop healthier lifelong eating habits.
\hen Nev York Cty, the country's urgest schoo dstrct,
stopped selling junk food in its schools and made other
mprovements n nutrton, physcu uctvty und chd- und
purent-educuton both n the schoos und cty-vde, rutes o
obesity among its kindergarten through eighth-grade children
dropped by 5.5 percent dstrct-vde n ust our yeurs. 1hese
decreused rutes o obesty ncuded 7 und 6 percent drops
umong buck und Hspunc 5- to 6-yeur-ods und u drumutc
24 percent drop in rates of obesity among white children
thut uge. 1hut s proo thut urge-scue pubc heuth chunge
is possible in a short time and
that the earlier you make those
chunges n u chd's e, the
better. Other places such as
Philadelphia and the state of
Mississippi are also beginning
to see real progress in reducing
childhood weight problems.
Finding ways to reverse our
epidemic of obesity is crucial
becuuse the L.S. Depurtment
o Deense uone spends un
estimated $1 billion per year for
medical care associated with
weight-related health problems.
In a dramatic move to address
ths probem, the mtury s
bringing healthier foods to its
schoos, dnng uctes, und
vendng muchnes, but t cunnot
vn ths ght uone. 1he cvun
sector needs to do its part.
1he 300 retred generus und
admirals of MISSION: READINESS are
joining parents and nutritionists
in strongly supporting new efforts
to limit the sale of junk food in our schools. Removing the
junk food from our schools should be part of nationwide
comprehensve ucton thut nvoves purents, schoos und
communities in helping students build stronger bodies with
less excess fat. We need action to ensure that Americas
child obesity crisis does not become a national security
crisis.
Students in the United States
consume almost 400 billion
calories from junk food sold at
schools each year. If the calories
were converted to candy bars this
would equal nearly 2 billion bars
and weigh more than the aircraft
carrier Midway.
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An epidemic is spreading across the world
The abrupt increase in obesity among American youth has set
off alarms in Americas medical community. Unfortunately
many other Americans still are not aware of how rapidly
childhood obesity has increased.
1
As reported in the Journal of the American Medical
Association, 17 percent of girls age 12 to 19 years are now
suffering from childhood obesity (not just excess weight).
Even more boys in that age range are obese 20 percent
and the boys rates are still rising.
2

Obesity rates are even higher among adults. In fact, one-
third of all American adults are obese by the criterion used
for adults: a Body Mass Index (BMI) of over 30, according to
a survey by the Centers for Disease Control and Prevention
(CDC).
3
(A separate survey conducted by the CDC has state-
specic overweight and obesity data that are presented
in Appendix II.)
4
While there has been a near doubling
of obesity rates worldwide since 1980, no other major
countrys military forces face the challenges of weight gain
confronting Americas armed forces.
5
Our male rates of
being overweight or obese are higher than those of any
other major country, according to an analysis by the World
Health Organization.
6
A different study in The Lancet further
conrms that the U.S. has the highest BMIs for men and
women, combined, among high-income countries.
7

1 in 4 cannot join the military due to
excess weight
National surveys conducted for the military and by the CDC
show that approximately one in four young adults is unable
to serve because of excess body fat.
8
When weight problems
are combined with poor education, criminal backgrounds
and other problems, an estimated 75 percent of all young
adults could not serve in the military if they wanted to.
9
The military spends over a billion dollars a
year on weight-related diseases
Because our country has failed to improve tness and reduce
obesity among our youth, the military has had to work much
harder than in the past to recruit and retain enough qualied
men and women who can effectively serve our country. For
example, many accepted recruits are diverted to special
training to address their inadequate physical tness before
Still Too Fat To Fight
Almost 3 out of 4 adult American males are overweight or obese. The United States
has the highest rate of overweight males among all major countries.
U.S.
73%
Canada
66%
Mexico
68%
Argentina
67%
South Africa
62%
Ethiopia
7%
Brazil
54%
U.K.
66%
Germany
63%
Sweden
57%
Russia
56%
Japan
29%
Australia
67%
China
25%
India
10%
Saudi
Arabia
70%
!"#$"%&'(" *+ ,'-".
'(". /0 *# *1"# 23* '#"
*1"#2"4(3& 56,7 /89
Czech
Republic
70%
France
52%
Source: World Health Organization, 2012
Stlll 1oo lat to llght "
they can even begin regular basic training. The costs add
up. The additional medical expenses for soldiers on limited
duty in the Army because of sprains or bone fracture injuries
that are caused in part by some soldiers being less t or
overweight than other soldiers total half a billion dollars
a year.
10
The militarys TRICARE health insurance system
serves active duty personnel, their dependents and veterans.
It spends well over $1 billion a year on treating weight-
related diseases such as diabetes and heart disease. Many of
those costs can be eliminated once America becomes more
proactive in helping all its citizens to routinely become more
active and consume less calories.
11

Americas school lunch program impacts
military readiness
Following World War II, military leaders reported to Congress
that, during the war, at least 40 percent of rejected recruits
were turned away for reasons related to poor nutrition.
12
This
inspired Congress to establish the National School Lunch
Program in 1946.
More than 60 years later, school nutrition remains a national
security concern. In 2010, the retired generals and admirals
of MISSION: READINESS strongly supported passage of the
Healthy, Hunger-Free Kids Act. This important legislation
requires the U.S. Department of Agriculture (USDA) to
update nutrition standards for all school foods and beverages,
including competitive foodsthose sold outside of school
meal programs, in vending machines, in school stores and as
la carte items in the cafeteria.
As the Healthy, Hunger-Free Kids Act was making its way
through Congress, MISSION: READINESS issued the report Too
Fat to Fight, which focused on the importance of providing
healthy school foods.
13
The Act had bipartisan support in
both the Senate and the House and was signed into law in
December 2010.
Since December 2010, the USDA has nalized regulations
to update standards for school meals. The nal standards
will allow for more fruits and vegetables, whole grains, and
low fat dairy products. The USDA hopes to nalize nutrition
standards for competitive foods and beverages sold at school
by the end of 2012.
MISSION: READINESS applauds the USDA for its efforts thus far in
updating nutrition standards for meals and looks forward to
the nalized standards for competitive foods and beverages.
We urge Congress to support the regulatory process and al-
low the USDA to nalize updated standards with input from
nutrition experts and other knowledgeable experts on school
nutrition policies.
School junk food calories equal more than
the weight of the aircraft carrier Midway
How is it that the amount of junk food sold to children at
U.S. schools in a single year is equal, in calories, to almost
2 billion candy bars, more than the weight of the aircraft
carrier Midway?
In 2005, scientists at the USDA conducted an in-depth
survey of childrens food and beverage consumption. They
found that, on any given day, almost 40 percent of
children in elementary through high schools 16
million children consumed one or more competitive
foods that were high-calorie, low-nutrient junk food, or
sugar-sweetened beverages. These were foods obtained
in school, but outside of the regular lunches.
14
K-12
students who reported in the USDA survey that they were
consuming high-calorie, low-nutrient food obtained
at school averaged over 130 calories a day from these
desserts, candy, chips, or other junk food, even exluding
sugary drinks or sodas.
15
The 130 calories a day for all students consuming junk food
equals almost 400 billion "empty" calories a year from foods
low in nutrients and high in solid fats and added sugar. Our
calculations show that those calories would equal nearly 2 billion
candy bars, which would weigh almost 90 thousand tons more
than the weight of the aircraft carrier Midway.
16
[For a fuller
explanation of how this gure was derived, see Appendix I]
General Richard E. Hawley,
US Air Force (Ret.)
In the ci vi l i an worl d, unfi t or
overweight employees can impact
the bottom line. But in our line of
work, lives are on the line and our
national security is at stake.
Stlll 1oo lat to llght #
National surveys on access to these foods, not actual
consumption, conducted by the research program Bridging
the Gap indicate that junk food and sugary drinks are still
widely available to students in elementary, middle and
high schools.
17
The USDA has not repeated its consumption
survey, but from the Bridging the Gap data on access to these
foods and other data, it is clear that junk food sold in schools
remains a major problem.
Exactly what do 130 calories per day from junk food mean
in the long run for growing children? A study in the journal
Pediatrics of child weight gain each year from 1998 to 2002
found that American youth consumed 110 to 165 more
calories than they required each day. Over a 10-year period,
those calories led to an excess 10 pounds of body weight for
all teens.
18
Clearly, children consuming an additional 130
calories in junk food sold at school each day is part of the
obesity problem.
Children who are unable to buy junk food at school may
seek to replace that food with other alternatives. The solution
involves children consuming fewer empty calories inside and
outside of school each day while eating more nutritious foods
and getting more exercise. The bottom line, as many parents
and nutritionists point out, is that we cannot succeed in
teaching our children to eat healthier foods while continuing
to sell junk food in our schools.
Getting rid of junk food is an essential part
of what works
Getting the junk food out of schools and serving nutritious
school meals is both challenging and possible. It is unlikely
that schools can successfully educate children about the
need to improve their eating habits if the schools contradict
that message by continuing to sell junk food. When New
York City combined limiting junk food in its schools with
other improvements in nutrition, physical activity, and
child- and parent-education that took place not only in the
schools but city-wide, rates of obesity among its K-8 children
dropped by 5.5 percent in just four years. The younger the
children the greater the decline in obesity. There was a 24
percent drop in rates of obesity among white 5- to 6-year-
olds and 7 and 6 percent drops among black and Hispanic
children that age proof that large-scale public health
change is possible in a short time frame and the earlier we
make these changes in childrens lives the better.
28

Other places, such as Philadelphia and the state of
Mississippi, are also starting to see meaningful progress in
reducing childhood obesity.
An issue brief by the Robert Wood Johnson Foundation
compared New York and Philadelphia, noting that, In the
mid 2000s, both cities implemented strong nutrition standards
to improve the foods and beverages available to students.
29

Philadelphia also improved school nutrition education,
worked to make fresh fruits and vegetables more available
in underserved neighborhoods, and had citywide public
education campaigns to encourage healthier nutrition. Over
a 4-year period, there was almost a 5 percent decline in the
overall obesity rate for Philadelphia's K-12 students. The largest
declines were observed among African-American males and
Hispanic females.
30
The brief also highlighted progress made in Mississippi. Over
a 6-year period, from the spring of 2005 to the spring of
Marines lead children in exercise at a MISSION: READINESS
news event in San Diego.
1he lentugon spends S4.5 bon u yeur on ood
services. In the most sweeping changes of military food
servces n 20 yeurs, the Armed Servces ure brngng
heuther oods vth more ruts, vegetubes, vhoe gruns
und over-ut oerngs to dnng uctes, Depurtment o
Deense (DCD) schoos, und other puces vhere servce
members und ther umes buy ood on buse, ncudng
vending machines and snack bars.
36
As Dr. }onuthun \oodson, Assstunt Secretury o Deense
or Heuth Aurs, expuned, Cur prmury ocus s
on the heuth und ve-beng o our servce members,
their families and our retirees. Obesity is a preventable
probem vhch, combuted, cun hep prevent dseuse
und euse the burden on our overu Mtury Heuth
System. He emphuszed the specu need to begn
teaching children healthy eating habits that can last a
lifetime.
37
\oodson noted thut the DCD consders obesty
not ony u nutonu probem, but u nutonu securty
issue. About a quarter of entry-level candidates are too
overweight to actually either enter the military or sustain
themseves through the rst enstment.
38
As t hus ut crucu tmes n the pust, the mtury s once
ugun eudng by exumpe. Ater servng ther country,
when young men and women from all over America
return to ther communtes, ther heuther eutng und
exercise habits can become not just the military way of
dong thngs, but uso the Amercun vuy o ncudng
healthier eating and exercise habits into daily life.
Leading by Example
Stlll 1oo lat to llght $
Many young men and women create challenges for the
military because they
ure too heuvy to on,
become too heuvy once they ure n the mtury, or
have weak muscles or bones from poor nutrition
and exercise habits that can lead to excess sprains or
stress fractures.
When the military could not meet recruitment goals during
the lruq vur, Congress expunded the number o mtury
recruters und ncreused bonuses or nev recruts. 1he Army
expermented vth ucceptng physcuy t recruts vho hud
more excess body fat than previously allowed.
19
1he Army
ound thut those overveght recruts vere 47 percent more
likely to experience a musculoskeletal injury (such as a sprain
or stress fracture) and that more overweight recruits had to
recycle back through boot camp.
20
1he Army hus stopped
accepting those overweight recruits.
Poor nutrition and a lack of physical exercise not only leave
young peope too overveght to on, they uso huve un mpuct
on those vho ure uccepted. \he recruts huve, on uveruge,
more musce muss thun recruts n pust decudes, they uso
have more body fat thus placing them at risk of becoming
overveght. 1here ure uso physcuy unt (though not
overweight) recruits who can and do enter since the military
does not test the physcu tness o recruts unt they urrve
at boot camp.
21
ln one study, l4 percent o nev Army mue
recruits said they had not exercised or done any sports in a
typical week prior to joining.
22
Of recruits who could not do
ll pushups upon entry, 45 percent dd not compete boot
camp.
23
\e uso knov rom mtury reseurch thut ess t
recruits are more prone to leg and ankle injuries.
24
Aong vth nudequute musce muss due to uck o exercse,
some recruits have low levels of bone density that can be due
to uck o exercse, ov eves o cucum und/or nudequute
ntuke o Vtumn D.
25
It has not helped that in recent decades
many children have switched from drinking milk to drinking
excess empty calories from sugared sodas. Research also
conrms thut chdren vho consume oods und beveruges thut
are not part of the regular school meals take in less calcium
and other important nutrients needed to build strong bodies.
26

All of these unhealthy situations can have an impact on
military readiness. Injured soldiers often cannot be deployed
with their units and a soldiers failure to pass the militarys
physcu tness tests cun resut n dschurge. \orse, more
soldiers were evacuated from Iraq or Afghanistan for serious
sprains and fractures than for combat injuries.
27
1he mtury s
working hard to reduce sprain and stress fractures. While it is
true thut even uy t soders suer spruns or ructures under
combut condtons or durng trunng, overveght or ess-t
young men and women are at higher risk for these injuries.
No one blows a whistle to stop the war when
a soldier goes down with a sprain or stress fracture. Being
overweight and/or physically weak increases the risk of
having a sprain or stress fracture.
Both overweight and physically unBt young adults impact
national security
Changes Over Two Decades in the Consumption of
Calcium and Sugar by Americas Children
Percent of Total Calories from Sugar-
Sweetened Beverages Consumed In and Out
of School (sodas and sugared-fruit drinks)
vs.
Calories from Milk*
Children Ages 2-18
1977-78 to 1999-2001
5%
10%
15%
20%
5%
10%
15%
20%
1977-78 1989-91 1994-96 1999-2001
*This measures calories, not ounces.Thus some of the decline in calories consumed for milk may
be due to greater consumption of lower-fat milk. However, school-age children still obtained
roughly two-thirds of their milk from whole fat milk in 2005-2006 and total milk consumption per
capita in America is declining.
Percent of
Total Daily
Calorie
Intake
Source: American Journal of Preventive Medicine, 2004
Stlll 1oo lat to llght %
2011, there was a 13 percent decline in the overall rate of
overweight and obesity among Mississippi's K-5 students. The
brief described the state's efforts to reduce obesity, including:
"In 2006, the Mississippi State Board of Education set
nutritional standards for foods and beverages sold in
school vending machines. The Healthy Students Act of
2007 required the states public schools to provide more
physical activity time, offer healthier foods and beverages,
and develop health education programs."
31
Progress made in New York City, Philadelphia and Mississippi
suggests that removing junk foods and offering healthy foods
at school is an important part of successful efforts to reduce
childhood obesity.
Will schools lose revenue by eliminating
junk food?
Some school districts have used prots from food sold
outside of the regular school lunch program to fund their
extracurricular activities and other school activities. Studies
show that decreased sales of junk food can be offset by
increased sales of regular school meals as kids buy more
healthy meals. Instead of using their familys lunch money
to purchase junk food on the la carte line in the school
cafeteria, or from school stores or vending machines,
children will be encouraged to make healthier choices.
According to a CDC review of the literature on limiting
sales of junk food, While some schools report an initial
decrease in revenue after implementing nutrition standards,
a growing body of evidence suggests that schools can have
strong nutrition standards and maintain nancial stability.
For example, the CDC noted one evaluation nding that, of
the 11 schools that reported nancial data, 10 experienced
increases of more than 5 percent in revenue from meal
program participation, which offset decreases in revenue
from la carte food service.
32

Reports from around the country reinforce the research. For
example, the director of food and nutrition for Norwood
School District in Ohio, Roger Kipp, eliminated vending
machines and school stores in his district and created an area
in the lunchroom where students could buy wraps, fruit or
yogurt. He explained the eventual success of the change: It
took a while, but it caught on. You have to give the kids time.
You cant replace 16 years of bad eating habits overnight.
33
In
New York City, a pilot program with special vending machines
serving fresh fruit sells out almost every day and has to be
restocked. According to Gerald Martori, principal at Benjamin
N. Cardoza High School, It was pretty much an instant hit.
34
U.S. Secretary of Agriculture Tom Vilsack has also reminded
people to read the Healthy, Hunger-Free Kids Act: It doesnt
ban cookies. It doesnt ban bake sales. The Act is aimed
at limiting the routine selling of junk food in school stores,
vending machines or the cafeteria line.
35
The risk is not behind us
The childhood obesity epidemic is still threatening our
national security. In fact, the rate of obesity is still climbing
among boys age 12 to 19 years. When the impact of the
recession is over and fewer people seek to join the military,
or if America is drawn into a new conict, our military
could again have trouble nding a sufcient number of well-
educated recruits without serious criminal backgrounds, or
excess body fat. Even among those who can be admitted, if
they are physically unt from a lifetime of nutritionally weak
diets and lack of exercise, they will be more prone to injuries.
[The child nutrition act] doesnt ban
bake sales.
Secretary of Agriculture Tom Vilsack
Why Fitness Matters
Souro. US Dopartmont ol Dolonso !"#$"% wobslto
US Marine Corps Sergeant
Andy Lee und hs .50 Cu-
ber Muchne Cun teum
had already had a rough
day. As temperatures ap-
proached 110 degrees in
Aghunstun, euch member
of the team was carrying
machine gun components
or ammunition weighing
over 90 pounds through
extremey dcut terrun.
When two squads ahead
of them came under small arms and rocket-
propeed grenude re, Lee und hs teum rushed
200 meters orvurd nto the dunger zone, set up
their gun and ignoring the risks to themselves
started suppressing the attack on their fellow
Murnes. Lee run to retreve more heuvy ouds o
ummunton, runnng buck to nd thut u rocket-
propelled grenade had injured the gunner on
hs teum. Lee supervsed the evucuuton o the
injured Marine while continuing to provide ma-
chine gun support for the two squads of Marines
vho hud come under uttuck. lor hs personu
vuor, physcu toughness, und devoton to the
msson, he vus uvurded the ronze Stur, on-
ing his uncle who had earlier received the same
medu ut Cuuducunu durng \ord \ur ll.
!"#$%& ()*" +&,-.-&$)/
0( 1*"- $& 2#".3
(&"4&*$) 5$67 8&&
Stlll 1oo lat to llght &
Conclusion
As retired admirals and generals, we know that America is not
powerless in the face of this insidious epidemic. We do not have
to keep surrendering ever more of our young people to obesity.
We do not need to keep jeopardizing our national security
because three quarters of our young people cannot serve in the
military, a quarter of them because they are overweight.
Getting the junk food out of our schools is the obvious next
step in our efforts to address the childhood obesity crisis.
Congress should continue to provide bipartisan support for
the process they approved to ensure that our children have
access to more nutritious, lower-fat, lower-calorie food at
school that includes fruits and vegetables, whole grains and
lower-fat dairy options. These foods can help our children
become strong and healthy. As a nation, we acted decisively
to improve our childrens nutrition after World War II and we
should do so again.
Endnotes
1 Ogden, C.L., Carroll, M.D., Kit, B.K., & Flegal, K.M. (2012). Prevalence of obesity and trends in body mass index among
US children and adolescents, 1999-2010. JAMA, January 12, 2012 (Online), E1-E8; Ogden, C.L., Flegal, K.M., Caroll,
M.D., & Johnson, C.L. (2002). Prevalence and trends in overweight among US children and adolescents, 1999-2000.
JAMA, 288(14), 1728-1732.
2 Ogden, C.L., Carroll, M.D., Kit, B.K., & Flegal, K.M. (2012). Prevalence of obesity and trends in body mass index among
US children and adolescents, 1999-2010. JAMA, January 12, 2012 (Online), E1-E8; Ogden, C.L., Flegal, K.M., Carroll,
M.D., & Johnson, C.L. (2002). Prevalence and trends in overweight among US children and adolescents, 1999-2000.
JAMA, 288(14), 1728-1732.
3 Wang, Y.C., McPherson, K., Marsh, T., Gortmaker, S.L., & Brown, M. (2011). Health and economic burden of the
projected obesity trends in the USA and the UK. The Lancet, 378, 815-25.
4 Data from the Centers for Disease Control and Preventions Behavioral Risk Factor Surveillance System (BRFSS) were
used to estimate three-year weighted averages of the proportion of 18- to 24-year-olds who are overweight and obese ac-
cording to the standard Body Mass Index cutoffs of 25.0 for overweight and 30.0 for obesity. We used three-year weighted
averages to obtain an acceptable sample size. Centers for Disease Control and Prevention. (2011). Behavioral Risk Factor
Surveillance System Prevalence trends and data. Atlanta, GA: Author. Retrieved on February 10, 2012 from http://apps.
nccd.cdc.gov/BRFSS/page.asp?cat=OB&yr=2010&state=All#OB
5 Finucane, M.M., Stevens, G.A., Cowan, M.J., Danaei, G., Lin, J.K., Paciorek, C.J., et al. (2011). National, regional, and
global trends in body-mass index since 1980: Systematic analysis of health examination surveys and epidemiological stud-
ies with 960 country-years and 9.1 million participants. The Lancet, 377, 557-567.
6 Finucane, M.M., Stevens, G.A., Cowan, M.J., Danaei, G.,Lin, J.K., Paciorek, C.J., et al. (2011). National, regional, and
global trends in body-mass index since 1980: Systematic analysis of health examination surveys and epidemiological
studies with 960 country-years and 9.1 million participants. The Lancet, 377, 557-567; World Health Organization.
(2012). Overweight and obesity. Global Health Observatory (GHO). Geneva: Author. Retrieved on February 10, 2012 from
http://www.who.int/gho/ncd/risk_factors/overweight/en/index.html
7 Finucane, M.M., Stevens, G.A., Cowan, M.J., Danaei, G., Lin, J.K., Paciorek, C.J., et al. (2011). National, regional, and
global trends in body-mass index since 1980: Systematic analysis of health examination surveys and epidemiological stud-
ies with 960 county-years and 9.1 million participants. The Lancet, 377, 557-567.
8 Center for Accessions Research (CAR), United States Army Accessions Command, Fort Knox, KY. Data provided by Lt.
Colonel Gregory Lamm, Chief, Marketing and Research Analysis Division, February 25, 2010; Cawley, J., & Maclean, J.C.
(2010). Unt for service: The implications of rising obesity for US Military recruitment. Cambridge, MA: National Bureau
of Economic Research. The Accession Commands estimate that 27 percent of 17- to 24-year-old Americans are too heavy
to join is based in part on a survey done for them by the Lewin Group in 2005. The National Bureau Economic Research
(NBER) study is an analysis of data from the National Health and Nutrition Examination Survey (NHANES) study. The NBER
analysis looks at eligibility rates for males and females based on BMI, body fat and exclusion criteria broken out for the
different services. Based on the NBER analysis, we conclude that approximately 23 percent of adults eligible by age would
not be able to join the Army because of excess body fat. Taking both studies into account the NBER analysis of NHANES
data and the Accessions Commands analysis we conclude that approximately one-quarter of young Americans would
be too heavy to join the military if they chose to do so. For a more recent military reference to the one in four gure see:
Associated Press. (February 10, 2012). Military to ght fat in food upgrade. Boston Globe. Retrieved on February 24, 2012
from http://www.bostonglobe.com/news/nation/2012/02/10/military-ght-fat-food-upgrade/9Aw1M6HOruUVXJFzAA6BAP/
story.html
9 Gilroy, C. (March 3, 2009). Prepared statement of Dr. Curtis Gilroy, Director of Accession Policy in the Ofce of the
Under Secretary of Defense for Personnel & Readiness. Before the House Armed Services Personnel Subcommittee.
Recruiting, Retention and End of Strength Overview.
10 Sample, D. (October 11, 2011). Army wants more soldiers back on deployable status. Army News Service. Retrieved
on February 10, 2012 from http://www.army.mil/article/67037/Army_wants_more_Soldiers_back_on_deployable_status\
11 Dall, T.M., Zhang, Y., Chen, Y.J., Wagner, R.C., Hogan, P.F., Fagan, N.K., et al. (2007). Cost associated with being
overweight and with obesity, high alcohol consumption, and tobacco use within the Military Health Systems TRICARE
prime-enrolled population. American Journal of Health Promotion, 22(2), 120-139.
12 U.S. Congress. (1945). House of Representatives 49th Congress 1st Session, Hearings Before The Committee on
Agriculture on H.R. 2673, H.R. 3143 (H.R. 3370 Reported). Bills Relating to the School-Lunch Program, March 23-May
24, 1945. Testimony of Major General Lewis B. Hershey.
13 Larson, N., & Story, M. (2010). Are Competitive Foods sold at school making our children fat? Health Affairs, 29(3),
430-435.
14 Fox, M.K., Gordon, A., Nogales, R., & Wilson, A. (2008). Availability and consumption of competitive foods in US
public schools. Journal of the American Dietetic Association, 109, S57-S66.
15 Fox, M.K., Gordon, A., Nogales, R., & Wilson, A. (2008). Availability and consumption of competitive foods in US
public schools. Journal of the American Dietetic Association, 109, S57-S66.
16 A Calorie Counter. (2012). Candy & chocolate bars compared: Hersheys, Nestle and Mars nutrition facts. Retrieved on
March 30, 2012 from http://www.acaloriecounter.com/candy-chocolate.php. For the complete explanation and endnotes,
see appendix I.
17 Johnston, L.D., OMalley, P.M., Terry-McElrath, Y.M., Freedman-Doan, P., & Brenner, J.S. (2011). School policies and
practices to improve health and prevent obesity: National secondary school survey results, school years 200607 and
200708. Volume 1. Executive Summary. Ann Arbor, MI: Bridging the Gap Program, Survey Research Center, Institute for
Social Research.Retrieved on May 5, 2012 from www.bridgingthegapresearch.org/research/secondary_school_survey
18 Wang, Y.C., Gortmaker, S.L., Sobol, A.M., & Kuntz, K.M. (2006). Estimating the energy gap among US children: A
counterfactual approach. Pediatrics, 118(6), e1721-e1733.
19 Alvarex, L. (January 18, 2009). More Americans joining military as jobs dwindle. The New York Times. Retrieved on
January 27, 2012 from http://www.nytimes.com/2009/01/19/us/19recruits.html?pagewanted=all; Asch, B.J., Heaton, P.,
Hosek, J., Martorell, P., Simon, C. & Warner, J.T. (2010). Cash incentives and military enlistment, attrition, and reenlist-
ment. Santa Monica, CA: RAND Corporation. Retrieved on January 27, 2012 from http://www.rand.org/pubs/monographs/
MG950.html; Cowan, D.N., Bedno, S.A., Urban, N., Yi, B., & Niebuhr, D.W. (2011). Musculoskeletal injuries among
overweight Army trainees: Incidence and health care utilization. Occupational Medicine, 61(4), 247-252.
20 Cowan, D.N., Bedno, S.A., Urban, N., Yi, B., & Niebuhr, D.W. (2011). Musculoskeletal injuries among overweight
Army trainees: Incidence and health care utilization. Occupational Medicine, 61(4), 247-252.
21 Knapik, J., Grier, T., Spiess A., Swedler, D., & Jones, B. (2009). Secular trends in the physical tness of infantry soldiers:
Are soldiers less t today than in the past? Presented at the Armed Forces Health Protection Conference, Albuquerque,
NM, 19 August 2009.
22 Swedler, D.I., Knapik, J.J., Williams, K.W., Grier, T.L., & Jones, B.H. (n.d.). Risk factors for medical discharge from
United States Army basic combat training. Aberdeen Proving Ground, MD: US Army Center for Health Promotion and
Preventive Medicine.
23 Six percent of young male recruits could not do even eleven pushups. Allison, S., Knapik, J., & Sharp, M. (2006).
Preliminary derivation of test item clusters for predicting injuries, poor physical performance, and overall attrition in basic
combat training. USARIEM Technical Report T07-06. Natick, MA: U.S. Army Research Institute of Environmental Medicine.
24 Knapik, J.J., Ang, P., Reynolds, K., and Jones, B. (1993). Physical tness, age and injury incidence in infantry soldiers.
Journal of Occupational Medicine, 35, 598-603; Lee, D. (2011). Stress fractures, active component, U.S. Armed Forces,
2004-2010. Medical Surveillance Monthly Report, 18(55), 8-11.
25 Bachrach, L.K., & Sils, I.N. (2011). Bone densitometry in children and adolescents. Pediatrics, 127(1), 189-194.
26 Templeton, S.B., Marlette, M.A., & Paneemangalore, M. (2005). Competitive foods increase the intake of energy and
decrease intake of certain nutrients by adolescents consuming school lunch. Journal of the American Dietetic Association,
105(2), 215-220.
27 Soldiers were 79 percent more likely to be evacuated to Germany from Iraq or Afghanistan for seriouis sprains or stress
fractures (musculoskeletal/connective tissue disorders) than for combat injuries. Cohen, S.P., Brown, C., Kurihara, C.,
Plunkett, A., Nguyen, C., & Strassels, S.A. (2010). Diagnoses and factors associated with medical evacuation and return to
duty for service members participating in Operation Iraqi Freedom or Operation Enduring Freedom: a prospective cohort
study. The Lancet, 375, 301-09.
28 Centers for Disease Control and Prevention. (2011). Obesity in K-8 students New York City, 2006-07 to 2010-11
school years. Morbidity and Mortality Weekly Report, 60(49), 1673-1678.
29 Robert Wood Johnson Foundation. (2012). Health policy snapshot: Childhood obesity. Princeton, New Jersey: Author.
Retrieved on September, 11, 2012, www.rwjf.org/healthpolicy
30 Robert Wood Johnson Foundation. (2012). Health policy snapshot: Childhood obesity. Princeton, New Jersey: Author.
Retrieved on September, 11, 2012, www.rwjf.org/healthpolicy; Robbins, J.M., Mallya, G., Polansky, M., & Schwartz, D.F.
(2012). Prevalence, disparities, and trends in obesity and severe obesity among students in the Philadelphia, Pennsylvania,
School District, 2006-2010. Preventing Chronic Diseases, 9. Retrieved on September 11, 2012 from http://www.cdc.gov/
pcd/issues/2012/12_0118.htm
31 Robert Wood Johnson Foundation. (2012). Health policy snapshot: Childhood obesity. Princeton, New Jersey: Author.
Retrieved on September, 11, 2012, www.rwjf.org/healthpolicy; : Kolbo, J.R., Zhang, L., Molaison, E.F., Harbaugh, B.L.,
Hudson, G.M., Armstrong, M.G., et al. (2012). Prevalence and trends in overweight and obesity among Mississippi public
school students, 2005-2011. Journal of the Mississippi State Medical Association, 53(5), 140-146.
32 Centers for Disease Control and Prevention. (n.d.). Implementing strong nutrition standards for schools: Financial
implications. Atlanta: Author. Retrieved on January 27, 2012 from http://www.cdc.gov/healthyyouth/nutrition/pdf/nan-
cial_implications.pdf
33 Nixon, R. (February 20, 2012). New guidelines planned on school vending machines. The New York Times. Retrieved
on February 24, 2012 from http://www.nytimes.com/2012/02/21/us/politics/new-rules-planned-on-school-vending-
machines.html
34 Hu, W. (October 3, 2011) At 14 schools, the venging machines crunch comes from carrots,The New York Times.
Retrieved on May 1, 2012 from http://www.nytimes.com/schoolbook/2011/10/03/at-14-schools-the-vending-machines-
crunch-is-from-carrots
35 Hartman, B. (December 10, 2010). The day the bake sales died? Ag Sec Tom Vilsack responds to Sarah Palin nanny
state concerns. ABC News. Retrieved on March 1, 2012 from http://abcnews.go.com/blogs/politics/the-note
36 U.S. Department of Defense. (2012). DOD to improve nutrition standards across the Armed Services for the rst
time in 20 years. Arlington, VA: Author. Retrieved on February 24, 2012 from http://www.defense.gov/releases/release.
aspx?releaseid=15052; Associated Press. (February 10, 2012). Military to ght fat in food upgrade. Boston Globe.
Retrieved on February 24, 2012 from http://www.bostonglobe.com/news/nation/2012/02/10/military-ght-fat-food-
upgrade/9Aw1M6HOruUVXJFzAA6BAP/story.html
37 Associated Press. (February 10, 2012). Military to ght fat in food upgrade. Boston Globe. Retrieved
on February 24, 2012 from http://www.bostonglobe.com/news/nation/2012/02/10/military-ght-fat-food-
upgrade/9Aw1M6HOruUVXJFzAA6BAP/story.html
38 Associated Press. (February 10, 2012). Military to ght fat in food upgrade. Boston Globe. Retrieved
on February 24, 2012 from http://www.bostonglobe.com/news/nation/2012/02/10/military-ght-fat-food-
upgrade/9Aw1M6HOruUVXJFzAA6BAP/story.html
39 Fox, M.K., Gordon, A., Nogales, R., & Wilson, A. (2008). Availability and consumption of competitive foods in US
public schools. Journal of the American Dietetic Association, 109, S57-S66.
40 American Beverage Association. (2010). Alliance school beverage guidelines nal progress report. Washington, DC:
Author. Retrieved on April 2, 2012 from http://www.ameribev.org/les/240_School%20Beverage%20Guidelines%20
Final%20Progress%20Report.pdf
41 Johnston, L.D., OMalley, P.M., Terry-McElrath, Y.M., Freedman-Doan, P., & Brenner, J.S. (2011). School policies and
practices to improve health and prevent obesity: National secondary school survey results, school years 200607 and
200708. Volume 1. Executive Summary. Ann Arbor, MI: Bridging the Gap Program, Survey Research Center, Institute for
Social Research, Robert Wood Johnson Foundation; Robert Wood Johnson Foundation. (n.d.). Executive summary: School
policies and practices to improve health and prevent obesity. Princeton, NJ: Author. Retrieved on February 10, 2012 from
http://www.bridgingthegapresearch.org/_asset/92v1fd/ES_2012_execsumm.pdf; Centers for Disease Control and Preven-
tion. (2011). School health proles 2010: Characteristics of health programs among secondary schools in selected US
cities. Atlanta: Author. Retrieved on March 30, 2012 from http://www.cdc.gov/healthyyouth/proles/2010/proles_report.
pdf . While the beverage industry had demonstrated reductions in sugared sodas sold to schools they contract with, the
RWJF study showed that, overall, sugar-sweetened beverages, including sugared juice drinks and sugary sports drinks, are
still highly accessible to students.
42 Fox, M.K., Gordon, A., Nogales, R., & Wilson, A. (2008). Availability and consumption of competitive foods in US
public schools. Journal of the American Dietetic Association, 109, S57-S66.
43 Cradock, A.L., McHugh, A., Mont-Ferguson, H., Grant, L., Barrett, J.L., Wang, C., et al. (2011). Effect of school district
policy change on consumption of sugar-sweetened beverages among high school students, Boston, Massachusetts, 2004-
2006. Prevention of Chronic Disease, 8(4), A74.
44 Fox, M.K., Gordon, A., Nogales, R., & Wilson, A. (2008). Availability and consumption of competitive foods in US
public schools. Journal of the American Dietetic Association, 109, S57-S66; In 2004-05, there were more than 43,000,000
1st through 12th grade students throughout the 50 states. National Center for Education Statistics. (2012). Common Core
of Data (CCD), State nonscal survey of public elementary/secondary education, 2004-05 v.1. Washington, DC: U.S.
Department of Education. Retrieved on January 27, 2012 from http://nces.ed.gov/ccd/bat
45 A Calorie Counter. (2012) Candy & chocolate bars compared: Hersheys, Nestle and Mars nutrition facts. Retrieved on
March 30, 2012 from http://www.acaloriecounter.com/candy-chocolate.php
46 A Calorie Counter. (2012) Candy & chocolate bars compared: Hersheys, Nestle and Mars nutrition facts. Retrieved on
March 30, 2012 from http://www.acaloriecounter.com/candy-chocolate.php
47 Historic Naval Ships Association. (2008). USS Midway (CV-41). Smitheld, VA: Author. Retrieved on February 10, 2012
from http://www.hnsa.org/ships/midway.htm
48 Data from the Center for Disease Controls Behavioral Risk Factor Surveillance System (BRFSS) was used to estimate
three-year weighted averages of the proportion of 18- to 24-year-olds who are overweight and obese according to the
standard Body Mass Index cutoffs of 25.0 for overweight and 30.0 for obesity. We used three-year weighted averages to
obtain an acceptable sample size. Centers for Disease Control and Prevention. (2011). Behavioral Risk Factor Surveillance
System Prevalence trends and data. Atlanta, GA: Author. Retrieved on February 10, 2012 from http://apps.nccd.cdc.gov/
BRFSS/page.asp?cat=OB&yr=2010&state=All#OB
49 Data from the Center for Disease Controls Behavioral Risk Factor Surveillance System (BRFSS) was used to estimate
three-year weighted averages of the proportion of 18- to 24-year-olds who are overweight and obese according to the
standard Body Mass Index cutoffs of 25.0 for overweight and 30.0 for obesity. We used three-year weighted averages to
obtain an acceptable sample size. Centers for Disease Control and Prevention. (2011). Behavioral Risk Factor Surveillance
System Prevalence trends and data. Atlanta, GA: Author. Retrieved on February 10, 2012 from http://apps.nccd.cdc.gov/
BRFSS/page.asp?cat=OB&yr=2010&state=All#OB
50 Data from the Center for Disease Controls Behavioral Risk Factor Surveillance System (BRFSS) was used to estimate
three-year weighted averages of the proportion of 18- to 24-year-olds who are overweight and obese according to the
standard Body Mass Index cutoffs of 25.0 for overweight and 30.0 for obesity. We used three-year weighted averages to
obtain an acceptable sample size. Centers for Disease Control and Prevention. (2011). Behavioral Risk Factor Surveillance
System Prevalence trends and data. Atlanta, GA: Author. Retrieved on February 10, 2012 from http://apps.nccd.cdc.gov/
BRFSS/page.asp?cat=OB&yr=2010&state=All#OB
51 This calculation of the excess pounds 18- to 24-year-old American women and men would have had to lose to be of
healthy weight (below a BMI of 25) in each state and nationally was originally calculated by the CDCs epidemiologist
who processes BRFSS data, Liping Pan, and provided in a table to MISSION: READINESS in a personal communication, March
18, 2010. It was originally reported in our national Too Fat to Fight report. In this report, it is adjusted to update the excess
weight gures for each state by multiplying it by the ratio of the current (2008-2010) average overweight percent, divided
by the prior (2006-2008) average percent overweight gure used in the Too Fat to Fight Report and the results are then
rounded to clarify it is a useful estimate, not a precise gure. Other ndings from that survey can be found at: National
Center for Chronic Disease Prevention & Health Promotion. (2011). Prevalence and trends data Overweight and obesity.
Behavioral Risk Factor and Surveillance System. Washington, D.C.: U.S. Department of Health and Human Services.
Retrieved on February 10, 2012 from http://apps.nccd.cdc.gov/BRFSS/page.asp?cat=OB&yr=2010&state=All#OB
52 The tank estimate is from: M1 Abrams main battle tank. Retrieved on April 9, 2012 from http://www.globalsecurity.org/
military/systems/ground/m1-specs.htm. One tank equals 60 tons, or 120,000 lbs.
Stlll 1oo lat to llght '
Appendix I
Students consume almost 400 billion junk food calories at school
per year, equal to almost 2 billion candy bars
The most authoritative survey of how much high-calorie, low-nutrient junk food and sugar-sweetened beverages are sold at schools was done in
2005 by the U.S. Department of Agriculture (USDA). The food and beverages were sold in vending machines, la carte at the end of the cafeteria
line or in school stores. The survey concluded that 40 percent of all elementary, middle and high school students bought and consumed such
competitive foods at school. They purchased and consumed an average of 177 calories per day of these high-calorie, low-nutrient foods.
39

Since the time of the survey, the major beverage companies have stopped marketing highly sugared sodas to schools, so to be conservative, we have
attempted to exclude all sugar-sweetened beverages from our junk food calorie count.
40
National surveys on access to food and beverages sold
outside of the school lunch program, not actual consumption surveys, conducted by the research program Bridging the Gap indicate that junk food
and sugary drinks are still widely available to students in elementary, middle and high schools.
41
Until the USDA repeats its consumption survey, we
will not know the exact situation, so for now, the USDA study results remain the best available data on junk food sold in schools.
130 calories per day:
Average calories from junk food and sugary drinks consumed by kids who ate junk food
obtained at school, according to the USDA study results published in the Journal of the
American Medical Association:
42
177 calories
Minus the calories that were from most sugary drinks even though some sugary
drinks are still available in many schools. The estimate of fewer calories is from a study
published by the CDC.
43
45 calories
Approximate junk food calories minus the sugary-drink calories = more than 130 calories
How many students:
40% of the 40,600,000 children in 1st through 12th grades in the United States
consumed junk food bought at school on the day they took the survey.
44 = 16,000,000 students
Days of the school year:
38 weeks x 5 days/week = 190 days
Almost 400 billion calories
130 calories per day x 16,000,000 students x 190 days
= almost 400 billion calories
(395,200,000,000)
Calories per candy bar:
45
= 210 calories
Almost 2 billion candy bars:
395.2 billion calories per year
210 calories per chocolate bar
46
= Almost 2 billion candy bars
(1,881,904,761)
And
43 grams per chocolate bar x 1,881,904,761 candy bars = 80,921,904,723 grams
-OR-
80,921,905 kilograms
80,921,905 kilograms
907 kilograms (1 ton)
= almost 90 thousand tons
The almost 90 thousand ton weight of 2 billion candy bars is well more than the 70 thousand ton
weight of the aircraft carrier Midway, the longest serving aircraft carrier in the U.S. Navy.
47

Primary Source: Fox, M.K., Gordon, A., Nogales, R., & Wilson, A. (2008). Availability and consumption of competitive foods in US public schools. Journal of the American Dietetic As-
sociation, 109, S57-S66. Additional Sources: See endnotes.
Stlll 1oo lat to llght (
Appendix II
Thirteen years ago, in only one state, Kentucky, were 40% or
more of young adults overweight or obese. Now forty states
have that many overweight or obese young adults.
48
j|ote. T|ese C|C oes ae oot t|e sae as t|e oeceotae o ooo aoo|ts |o eac| state .|o caooot ,o|o t|e |||ta.]
a
State
Highest to Lowest
2008-2010 average
Percent of 18- to
24-year-olds overweight
or obese
b, 49
1995-1997
Percent of 18-
to 24-year-olds
overweight or
obese
b, 50
Percent increase
During the 13 years
from 1996 to 2009
Excess pounds
Pounds needed to lose
to have no overweight or
obese young adults in the
state
c, 51
Abrams tanks
Equivalent weight in
Abrams tanks
d, 52
Mississippi 49% 37% 34% 3,800,000 32
Oklahoma 49% 30% 62% 4,500,000 38
Alabama 49% 36% 37% 9,600,000 80
West Virginia 49% 37% 33% 2,200,000 19
South Carolina 48% 36% 35% 6,000,000 50
Ohio 48% 30% 60% 20,000,000 165
South Dakota 47% 37% 26% 1,300,000 11
Texas 47% 38% 25% 35,000,000 290
North Carolina 47% 38% 24% 14,000,000 116
North Dakota 46% 33% 41% 1,300,000 11
Iowa 46% 33% 38% 4,700,000 39
Arkansas 46% 39% 19% 4,600,000 38
Kentucky 45% 41% 11% 5,300,000 44
Wyoming 45% 27% 66% 650,000 5
Louisiana 45% 34% 32% 6,400,000 53
Kansas 45% 35% 30% 3,900,000 33
Tennessee 45% 34% 32% 7,200,000 60
Nebraska 44% 30% 48% 2,200,000 18
New Hampshire 44% 31% 45% 1,300,000 11
Georgia 44% 32% 38% 11,000,000 87
Washington 44% 31% 42% 8,600,000 71
Nevada 43% 30% 42% 2,400,000 20
New Jersey 43% 30% 42% 11,000,000 92
Minnesota 43% 33% 28% 6,000,000 50
Delaware 42% 34% 23% 1,160,000 10
Hawaii 42% 33% 27% 1,400,000 12
Indiana 42% 34% 23% 7,500,000 62
California 42% 35% 19% 55,000,000 457
New Mexico 42% 35% 19% 2,700,000 23
Rhode Island 42% 32% 31% 1,000,000 9
Illinois 41% 33% 30% 21,000,000 173
Michigan 41% 38% 10% 15,000,000 125
Missouri 41% 37% 13% 7,400,000 62
Maryland 41% 33% 24% 7,200,000 60
Montana 41% 38% 8% 1,100,000 9
Pennsylvania 41% 33% 22% 16,000,000 136
Florida 40% 34% 19% 13,000,000 105
Wisconsin 40% 31% 31% 8,100,000 68
Maine 40% 39% 3% 1,100,000 9
Massachusetts 40% 28% 44% 7,700,000 64
Connecticut 39% 26% 49% 2,500,000 21
Vermont 39% 34% 14% 890,000 7
New York 39% 31% 26% 23,000,000 190
Oregon 39% 34% 13% 3,500,000 30
Idaho 38% 30% 29% 1,300,000 11
Colorado 36% 30% 21% 3,200,000 27
Virginia 34% 33% 3% 6,800,000 57
Utah 33% 27% 21% 2,900,000 24
USA 42% 33% 29% 386,300,000 3,219
Alaska, Arizona and the District of Columbia did not have enough data for different years to provide comparison estimates.
SOURCE: Centers for Disease Control and Prevention Behavioral Risk Factor Surveillance System (BRFSS), 2010 & 2012.
a
The percentage of overweight men and women in this data cannot be used to show how many young adults are unable to join the military due to their weight. The military
services use somewhat more lenient cutoff points and do not have state-level estimates.
b
T|ese oes ae baseo oo t|e C|C's 3||SS aoo ae aveaeo ove t|ee eas to ooooce soc|eot sao|e s|zes. T|e 3||SS |s oot easoeo t|e sae .a as t|e
C|C's |at|ooa| ea|t| aoo |ot|t|oo |a|oat|o Sove (|/||S) oata c|teo |o t||s eoot. 3ot t|e |/||S oata oo| |ave oat|ooa| eso|ts, .|eeas t||s sove |s
informative because it has state-level data.
c
T||s oata oo ecess ooooos .as oov|oeo to os o t|e C|C o oo o||oa| Too |at to |||t eoot (||ss|oo. |eao|oess. (20+0). Too at to |t. \as||otoo, |C. /ot|o.
|et|eveo o |tto.//coo.|ss|ooeao|oess.o/||_Too_|at_to_|||t-+.oo). \e |ave ao,osteo t|ose o||oa| oes to oov|oe o oe eceot oata o eac| state. (See
endnote 53)
d
One Abrams tank equals 120,000 pounds.
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